What are you doing to make your company better? If you are employed, then it is your company. Take stock in your employer. If you can make your company more efficient, then you deserve a raise. None of us should be getting raises for time served. It is not prison, at least it shouldn’t seem like prison. Find your passion and follow it. If you don’t have passion for at least one part of your job, then reassess your career path. Once you find IT, then make yourself valuable.
- “Process changes entails ‘looking for changes we can make within our system to become more efficient’”
If we believe that no system is perfect, and we can look at our own system (regardless of the profession or business) to ask ourselves ‘How can we be better’, then this will open Pandora’s box. For instance, I recently asked myself what can we as a department be doing better. There were a lot of suggestions that were thrown out. We delved into one suggestion and it a brick wall when we broached a certain subject. Pushing further, it turns out that another department limits our department. Our conversation didn’t go any further than this, but I would love to be in an upper level position to be able to bring the two departments together in order to demonstrate to the two departments how closely entwined they are with each other. This was just one suggestion of improvement that I discussed with my supervisor. In my opinion though, things will never change if they are never analyzed.
- “’In the end, whether it’s a clinical process or an operational one, anything you do that is part of that process must create value for your customer’”
Who is our “customer” in healthcare? The easy answer is the patient, but that answer is too easy and cookie cutter. I would challenge that answer. That is one of our customers, but maybe not THE customer. When we look in terms of retail, who is the customer? Is it everyone that is in the store…in an ideal setting, the answer is yes, but realistically our customer is the one that is spending money on our wares. In PT, the wares are PT. The customer (the one giving us the money) though is not the patient as much as it is the insurance company. How do we best create value for our payers? We fix our patients, which some believe to be our customers. This is not to demean the patient by any means, but we have to understand who feeds us. If the patient’s had to pay our of pocket, then I would say that the patient is the customer and that would create a different set of values.
- “Michael Porter, PhD, in The New England Journal of Medicine…defines value ‘as the health outcomes achieved per dollar spent.’…’Value should always be defined around the customer, and in a well-functioning health care system, the creation of value for patients should determine the rewards for all other actors in the system…value in health care is measured by the outcomes achieved, not the volume of services delivered…”
What this is saying is that the health care providers (therapists in this specific example) should get paid for doing a good job (meaning the patient gets better and avoids other costly procedures such as MRI’s, surgery, prolonged loss of work, etc) instead of getting paid for DOING a lot of stuff to the patient. In my opinion, this means that if you have back pain, then the therapist should get paid a certain amount for a specific outcome. If this outcome occurs in a short period of time, then the therapist makes more money per visit overall. There is value though in identifying patients that will not benefit from therapy and the therapist should also be rewarded for getting this patient to the proper practitioner to fix the problem. Another way to say this is that the therapist should be “punished” by having to refund money to the payer if the patient needs to undergo a surgery that the therapist though was avoidable. If we save the health care system a lot of money by avoiding surgery, then we should see a percentage of that health care savings. On the flip side, if we stated that the patient would do well with therapy and the patient did not do well, or needed surgery, then the money that we were paid should have to be paid back in order to help pay for the surgery. This is opening up a box, but as I stated before, the cream will rise to the top and those that are good at their job will learn how to maximize income by becoming better at fixing those that can be fixed and referring those that can’t be fixed on to someone else that can fix the patient.
- “Companies are seeking ways to reduce costs in response to health care reforms and in anticipation of the ever-closer move away from fee for service and toward value-based care”
This is all fine and dandy, but the companies need to inform the employees what is happening in the health care world. There are many companies, mine included, that have cut jobs, which has created a more stressful environment company-wide. We all hear, do more with less, but what should be said is that “we are getting paid less and have to get creative in order to continue to stay solvent”.
- “…the patient is the customer. Value, therefore, depends on patient experience…outcomes are greatly influenced by the amount of time the patient spends with actual caregivers”
My company does some things right and some things wrong. We need to assess the patient experience. This starts well before the patient is actually sitting in front of us for an evaluation. When the patient pulls into your business, is the entrance marked appropriately? Are you easy to find? Did your receptionist ensure that the patient had directions to get to your clinic? Now that the patient has found it, how easy is it to park? Does the patient have to walk a long way in order to see the clinician? Is the waiting room busy? Is the waiting room cluttered? Is the waiting room clean? Is there coffee? Is there demographic based reading material in the waiting room? Is the front desk staff warm and receptive? Does the front desk staff make an effort to remember patient names? When the patient registers for the first visit, are they simply handed paperwork to fill out, or does the receptionist offer to help? After registered, does the therapist come to the patient, or is the patient brought back to wait for the clinician? Is it a long walk to get to the clinic? Are there private rooms (or at least a private area) available to talk candidly with the patient, without the patient feeling stifled due to outsiders? Are the beds clean? Is the room inviting to the patient? Does the clinician have all the tools needed to take care of the patient?
This only describes the first 5 minutes of a patient experience and it can go on and on? Are companies still thinking about the patient experience, or simply the $$$.
I can say that my company does not ask me to violate any ethical considerations and as long as the patient is in the clinic, I am with the patient and caring for the patient. That patient is vulnerable, that’s why they are there, and I do my best to ensure that the patient understands that they are in a caring environment. This doesn’t always mean that I can help or “fix” the patient, but the patient understands that they will learn, be cared for, and get their money’s worth in the session.
- “The goal is to minimize the amount of time any patient must wait to be seen once he or she has called to make an appointment…3 days or less”
I have seen wait lists of up to 2 weeks to see the practitioner of choice. This is absurd. If the patient has to wait, the therapist better be fantabulous. This is uncalled for to have a wait list longer than 3 days. My first job, we prided ourselves in getting the patient in the clinic within 24 hours if the patient wanted to be seen. It meant sacrifice at times, but the patient was always my priority.
- “…examining the department’s intake procedure, its insurance verification process, and even the performance of individual PT’s who might become more efficient by changing some of their protocols”
All businesses, healthcare is not an exception, could stand to become better. There are many avenues in which to improve, as I listed many instances, which could be evaluated in the first 5 minutes of a patient experience. Could the therapist be better? Of course! Is the therapist doing something to become better…highly unlikely…unfortunately. (This is simply my observation over the course of 8 years in practice. Once we start getting paychecks and life happens, the professionalism and giddiness that we entered the profession with starts to get pushed down by other priorities)
- “Lean…all about continuous improvement-taking every functional area of your practice, business, department, or organization and continuously challenging everyone who is part of it to do things better.”
This can be scary. Imagine having someone telling you that “you suck”. Scary right?! It will never happen, but unfortunately, it’s what we hear when we are told that we have to change. We can all be challenged, but how we are challenged is what matters.
Story time: Sam’s club 8298 Joliet IL. The year was about 2002 and a new GM came to the store. David was a good leader. I was working in Tires at the time and there were about 4 of us in the department on this day. He asked me to do one job and report back to him when I was done. No one else was asked to do anything more, so I was the only one working while everyone else waited for the next customer. After the first job, he gave me another…and another…and another. Six hours later, I was frustrated and angry because I was the only one working. I confronted him about it after 6 hours and he said something along the lines of wanting to see how much he could push me before I pushed back. He was surprised that it took 6 hours, as he though it would take much less. I respected him more for that, only because he told me his end-game.
- “It (Lean) allows you to find the steps that are not providing value so you can eliminate them.”
Change is hard. It is hard to change what has always been done, but if no one looks at “what has always been done”, then we will never know if it can be done better, or needs to be done at all.
- “incremental changes are made to a process and either accepted or rejected depending on the results”
This is similar to what we do in an evidenced based version of healthcare. We attempt to change one variable and note the result. If the result was bad, then we change back to what we were doing originally and attempt to change a different variable in order to make the patient better. This is the same concept, just applying to business instead of patient care. The trick is to allow the variable some time in order to allow itself to show its change. For instance, if I were to offer valet parking, I couldn’t assess it in one day. It may take time for my patients to realize that this is offered and even longer still for it to become an everyday occurrence. When it is established, I can then take inventory on whether it is good/bad/indifferent and if the valet needs to be improved or eliminated.
- “You’re continuously making changes, but they’re easy to reverse…if you do something that doesn’t lead to significant improvements, you go back to what you were doing before.”
This is very self explanatory, but I rarely see it put into practice. Complacency is the killer of excellence. Unless we are constantly striving to improve, then we will be passed up by those that are.
- “if you want to come in and start your therapy today, you can, and you can make your appointments for whenever is most convenient for you. You just have to be willing to see different therapists”
This is a very simple concept, but if the patient is never made aware that they will be seeing different therapists, then the patient may not be as happy with the convenient time as they would with the same PT. This is something that my current company has tossed around, but has not taken 100% initiative with.
- “I would encourage any PT to see the journey in their setting from a patient’s perspective”
What would my patient’s think about their experience? I believe that the clinical aspect is covered thoroughly, but is there something else that I could be doing to enhance the experience?
- “Patient’s were starting late because it was taking too long to do all the paperwork. In that case, she says, ‘We brought everyone together to look at all the ways we had patients register. We then figured out what was absolutely necessary-as opposed to what we were doing just because we’d always done it that way…managed to reduce the average intake time by almost 10 minutes”
This is huge for me. I hate that I have to wait for a patient to complete all of the paperwork on the initial evaluation. When I have to wait for the patient, I am left with 2 options: cut the session short so that my next patient doesn’t have to wait, or make the next patient wait. Who is more important at this stage? It would be ideal for the patient to be completely registered prior to coming in for the first appointment. Why can’t this be done when the patient comes in to schedule?
- “’…quiet the external noise’ that too often exists in workplace environments…When we reduce that volume of noise, we free up our clinicians and frontline workers.”
This is interesting because this exact line was used in a previous e-mail from an employer. Unfortunately, just saying it doesn’t do much if the “leadership” doesn’t follow the same line. Noise could be anything from rumors, complaints, internal bullying, and anything that makes the frontline dissatisfied.
Excerpts taken from:
Hayhurst C. Why Physical Therapists Are Embracing Lean Management. PT in Motion. December 2015-January2016:24-28.
We all like to think of ourselves as important. “No one can do my job as good as I can.” We all think like this, or at least I hope we do.
You are not your MRI…at least not for long.
This is a great article for the “n” of one crowd. Not every article has to be a randomized control trial and sometimes we can learn much more from a case report than from a systematic review. This is one case report that taught me to be a little more exhaustive than I typically am when treating a patient. When a patient presents to the clinic with facial pain, the “jump to conclusion” idea is that the patient has larger issues that need to be addressed, as this is a sign of a cranial nerve (think direct to the brain nerve) dysfunction. I forgot some details of the nervous system, or a better way of saying it is that I didn’t have a complete understanding of this coming out of PT school that this review is more of a clinical application of the anatomy in order for it to make more sense. My ego is not too big to say that I am still learning daily. This article makes me a better therapist tomorrow than I was yesterday. Thank you J. Lincoln.
SCIATICA OF THE ARM
Dr. Vince Gutierrez, PT 